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Diagnostic performance of computed tomography and diffusion-weighted imaging as first-line imaging modality according to the International Myeloma Working Group (IMWG) imaging algorithm for monoclonal plasma cell disorders

Diagnostic performance of computed tomography and diffusion-weighted imaging as first-line... BackgroundThe latest International Myeloma Working Group (IMWG) guideline recommends low-dose whole-body (WB) computed tomography (CT) as the first-line imaging technique for the initial diagnosis of plasma cell disorders.PurposeTo evaluate diagnostic performances of CT and diffusion-weighted imaging (DWI) as the first-line imaging modalities and assess misclassification rates obtained following the guideline.Material and MethodsTwo independent radiologists analyzed CT (acquired as PET/CT) and DWI (3-T; b-values = 50 and 900 s/mm2) of patients newly diagnosed with plasma cell disorder, categorizing the number of bone lesions. Diagnostic performance of CT and DWI was compared using the McNemar test, and misclassification rates were calculated with a consensus WB-MRI reading as the reference standard. Differences in lesion number categories were assessed using marginal homogeneity and kappa statistics.ResultsOf 56 patients (36 men; mean age = 63.5 years), 39 had myeloma lesions. DWI showed slightly higher sensitivity for detecting myeloma lesions (97.4%) than CT (84.6%–92.3%; P > 0.05). CT showed significantly higher specificity (88.2%) than DWI (52.9%–58.8%; P<0.05). CT had a higher additional study requirement rate than DWI (7.7%–15.4% vs. 2.6%), but a lower unnecessary treatment rate (11.8% vs. 41.2%–47.1%). Both readers showed significant differences in categorization of the number of lesions on CT compared with the reference standard (P < 0.001), and one reader showed a significant difference on DWI (P = 0.006 and 0.098).ConclusionCT interpreted according to the IMWG guideline is a diagnostically effective first-line modality with relatively high sensitivity and specificity. DWI alone may not be an acceptable first-line imaging modality because of low specificity. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Acta Radiologica SAGE

Diagnostic performance of computed tomography and diffusion-weighted imaging as first-line imaging modality according to the International Myeloma Working Group (IMWG) imaging algorithm for monoclonal plasma cell disorders

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References (35)

Publisher
SAGE
Copyright
© The Foundation Acta Radiologica 2021
ISSN
0284-1851
eISSN
1600-0455
DOI
10.1177/02841851211008383
Publisher site
See Article on Publisher Site

Abstract

BackgroundThe latest International Myeloma Working Group (IMWG) guideline recommends low-dose whole-body (WB) computed tomography (CT) as the first-line imaging technique for the initial diagnosis of plasma cell disorders.PurposeTo evaluate diagnostic performances of CT and diffusion-weighted imaging (DWI) as the first-line imaging modalities and assess misclassification rates obtained following the guideline.Material and MethodsTwo independent radiologists analyzed CT (acquired as PET/CT) and DWI (3-T; b-values = 50 and 900 s/mm2) of patients newly diagnosed with plasma cell disorder, categorizing the number of bone lesions. Diagnostic performance of CT and DWI was compared using the McNemar test, and misclassification rates were calculated with a consensus WB-MRI reading as the reference standard. Differences in lesion number categories were assessed using marginal homogeneity and kappa statistics.ResultsOf 56 patients (36 men; mean age = 63.5 years), 39 had myeloma lesions. DWI showed slightly higher sensitivity for detecting myeloma lesions (97.4%) than CT (84.6%–92.3%; P > 0.05). CT showed significantly higher specificity (88.2%) than DWI (52.9%–58.8%; P<0.05). CT had a higher additional study requirement rate than DWI (7.7%–15.4% vs. 2.6%), but a lower unnecessary treatment rate (11.8% vs. 41.2%–47.1%). Both readers showed significant differences in categorization of the number of lesions on CT compared with the reference standard (P < 0.001), and one reader showed a significant difference on DWI (P = 0.006 and 0.098).ConclusionCT interpreted according to the IMWG guideline is a diagnostically effective first-line modality with relatively high sensitivity and specificity. DWI alone may not be an acceptable first-line imaging modality because of low specificity.

Journal

Acta RadiologicaSAGE

Published: May 1, 2022

Keywords: Magnetic resonance imaging; diffusion magnetic resonance imaging; multidetector computed tomography; whole-body imaging; multiple myeloma

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